| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0691 |
Uvl pnl 2 sq ft or less |
310 |
297 |
$20K |
| K0108 |
W/c component-accessory nos |
1,117 |
450 |
$9K |
| E2366 |
Battery charger, single mode |
303 |
283 |
$7K |
| K0739 |
Repair/svc dme non-oxygen eq |
850 |
702 |
$5K |
| E2365 |
U1 sealed leadacid battery |
170 |
157 |
$5K |
| E2386 |
Foam filled drive wheel tire |
75 |
72 |
$1K |
| E2394 |
Drive wheel excludes tire |
75 |
72 |
$760.05 |
| E2374 |
Hand/chin ctrl std joystick |
14 |
12 |
$591.48 |
| E2387 |
Foam filled caster tire |
28 |
27 |
$403.55 |
| E2396 |
Caster fork |
29 |
28 |
$318.63 |
| E2392 |
Solid caster tire, integrate |
32 |
29 |
$293.57 |